bK Summer camp 2wentyten

REGISTRATION FORM

PLEASE READ and PRINT CAREFULLY

www.ballistikyouth.com
E-mail- kontakt@ballistikyouth.com
Camper’s Name-
___________________________________________________________________________________________
Birth Date: ___/___/___ Gender: MALE or FEMALE
Age (as of Jan 1, 2010): ________Grade 2010): ______
Mailing Address-
___________________________________________________________________________________________
City- __________________________________________________State- ___________P/C- ________________
Mother or Guardian- __________________________Father or Guardian ________________________________
Mum’s E-mail - _________________________________Dad’s E-mail _________________________________
Phone Numbers:
Work # Mum (____)___________________ Work # Dad (____)___________________
Mobile # Mum (____)___________________ Mobile # Dad (____)___________________
Home # (____)___________________ Emergency # (____)___________________ Ask for _________________
Attended a bK camp before? YES _____ NO _____
(THIS FORM MUST BE COMPLETE IN FULL AND MUST BE SIGNED)

I, THE UNDERSIGNED, HAVE READ AND UNDERSTAND THE CAMP’S REGISTRATION INFORMATION. I GIVE
PERMISSION FOR BALLISTIK YOUTH AND ITS LEADERS TO SEEK ANY EMERGENCY MEDICAL TREATMENT DEEMED
NECESSARY IF UNABLE TO LOCATE ME. IT IS FURTHER AGREED THAT AS PART OF THE CONSIDERATION FOR THE
CAMP TO ACCEPT THE ABOVE NAMED CHILD AND FOR PARTICIPATION IN ALL CAMP ACTIVITIES, THE CAMP
SHALL NOT BE LIABLE FOR ANY DAMAGES WHATSOEVER IN THE EVENT OF INJURY, ILLNESS OF SAID CHILD BY
ANY CAUSE WHATSOEVER, INCLUDING ITS LEADERS, AND VOLUNTEERS THEREWITH OF ANY SUCH LIABILITY. I
RECOGNIZE THAT THIS IS A CHRISTIAN CAMP; THAT THE BIBLE WILL BE STUDIED, AND THAT CAMP CONDUCT
WILL BE EXPECTED TO BE CONSISTENT WITH CHRISTIAN VALUES. I AGREE THAT ANY PHOTOS/VIDEOS TAKEN AT
CAMP MAY BE PUT IN A ALBUM ON THE FOLLOWING BALLISTIK WEBPAGES; BALLISTIKYOUTH.COM,
MYSPACE.COM/BALLISTIK YOUTH AND BALLISTIKYOUTH’S FACEBOOK PAGE. AND THESE PHOTOS/VIDEOS MAY
BE SHOWN AT BALLISTIK’S YOUTH PROGRAM. I GIVE BALLISTIK YOUTH STAFF PERMISSION TO SEARCH
BACKPACKS AND BELONGINGS IF NEED BE FOR THE SAFETY OF ALL CAMP ATTENDEES.
PARENT or GUARDIAN SIGNATURE
DATE_____________
WITNESS FOR PARENT or GUARDIAN
DATE_____________
Medical Details: Does your child have any health issues that we need to be aware. Please state all
and any (This is so we can best care for your child. All details will be kept private and
confidential)
__________________________________________________________________________________________________
______________________________________________________________________________________________
________________________________________________________________________________________________Do
es your child take any medications, if so what are they and will they need help to take them?
________________________________________________________________________________________________
________________________________________________________________________________________________